Enrollment Coordinator

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Introduction

Visium Resources has been asked to identify qualified candidates for this Enrollment Ancillary Coordinator position. This position is a contract opportunity which is expected to be Remote for a duration of 3 Months with a possible extension.

The Enrollment Ancillary Coordinator is responsible for physician systems including applications and credentialing for various physician groups and specialties for which contracting services are provided.

• Maintains and updates all credentialing systems with current information for all physicians/providers.
• Responsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all physicians/providers for which we contract.
• Responsible for auditing and data analysis for all physician/provider credentialing records, documents, and files.
• Responsible for programming Network Management applications to generate reports necessary to ensure accuracy of physician/provider records.
• Actively participates in physician group leadership meetings and is accountable for presenting credentialing status for all groups.
• Provides continuous training, coaching, and mentoring to the Enrollment Specialists and Ancillary Coordinator.
• Serves as a resource to other Enrollment Specialists/Coordinator and works alongside Credentialing Manager and Director of Credentialing and Revenue Management to develop and implement new policies/procedures/standards.
• Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Essential Function:
Physician Groups and Systems

• Responsible for the credentialing efforts for primary care and/or specialist physician and/or mid-level providers employed by the Hospitals Division physician groups.
• Assigns new providers to another Enrollment Specialists/Coordinator depending upon workload.
• Ensure credentialing information is complete based on the requirements of the specific provider type.
• Responsible for understanding and utilizing the functionality of Network Management (or any subsequent credentialing database) and training new employees.
• Responsible for programming physician/provider applications within Network Management (or any subsequent credentialing database) and works to ensure physician/provider information is complete, accurate, and up to date.
• Ensure that credentialing applications are scanned and programmed to populate physician information.
• Assists in maintaining a complete database (including CAQH) of all credentialing materials for all employed physicians/providers.
• Utilizes advanced level of skill relating to the understanding of payer credentialing nuances and disseminates such information and trains team members as necessary.
• Tracks re-credentialing and vendor roster requests coming into the department.

Communication:

• Communicate with physician/provider office staff and practice management regarding the status of applications, additional materials required, etc.
• Educates physician/provider and physician/provider leadership staff on necessary documentation needed to credential physician/provider.
• Responsible for ensuring that all documents are up to date and new documents are requested from Practice Management for any that may be expiring.
• Effectively communicates and is accountable to staff, leadership, payors, providers, patients, and visitors.
• Works with internal and external partners to resolve issues concerning credentialing loads.
• Researches and resolves routine provider operational issues with internal and external partners.
• Effectively participates and plays an integral role in meetings and discussions with regional leadership to include Managed Care Directors, Physician Group Leadership, and staff regarding internal issues, physician onboarding issues and payer issues.
• Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues.

Support:

• Supports the Credentialing Manager and Director of Credentialing, Contracting and Revenue Management by resolving problems, questions, and issues internally, as well as at the payer and the practice.
• Supports physician contracting and operation services by auditing and analyzing data, verifying applications, preparing amendment letters, ensuring physician/provider credentialing materials are processed efficiently, professionally, and as expeditious as possible.
• Researches any inconsistencies or discrepancies assigned by leadership and educates the entire team of findings.
• Supports the Negotiators through notification of current application status and new contract requirements.
• Assists and guides physicians/providers in determining information necessary for applications.
• Supports the overall mission of the Hospital and the role of the Managed…